A lot of answers on forums are from 2004 ??// would good is that every one seems to take the line that 90-120mg is no better than 60 mg . well why did they make 90-and 120mg tablets if they're no better than 60mg and they're still saying this in 2017 ,i am on 60mg and my depression is better but my anxiety is the same , NNNNNNNNNNow will 90-120mg make my anxiety worse or better i am confused surely there have been enough test on patient to no the answer after 13 years , can anyone tell me if going up helped there anxiety or made it worse because i haven't a clue with this med:wacko::wacko::wacko:

panic_down_under

23-07-17, 13:18

every one seems to take the line that 90-120mg is no better than 60 mg

Yeah, you will read learned texts proclaiming that, usually then pontificating that this is because 60mg will block 80% of the serotonin transporters which supposedly is the magic number to produce the therapeutic effect and higher doses don't increase that percentage by much. Sounds really impressive...until you contemplate the French antidepressant tianeptine (Stablon) which not only doesn't block serotonin transporters, it actually increases their efficiency. Yet it seems to be at least as effective as the SSRIs and often works more quickly!

Now will 90-120mg make my anxiety worse or better

Apart from possibly a spike for a week or two, increasing the dose is unlikely to make anxiety worse. Whether it will make it better will only be determined by trying it.

i am confused surely there have been enough test on patient to no the answer after 13 years

There may be a generalized answer, but even if a million others all responded the same way, that's no guarantee you will, unfortunately. Everyone's reaction is unique to them.

MyNameIsTerry

23-07-17, 14:21

The thing is, doctors will often keep increasing the dosage hoping to see more improvement. This doesn't always achieve anything and they end up switching people.

SSRI's tend to hit their 80% at minimum therapeutic dosage and increases tend to add around 5%. I think it's debatable just how much benefit that creates and in the case of Citalopram we had the more recent decision it wasn't worth it to go beyond 40mg due to this % increase being so small (as well as the increased risk issue).

Whether their is an advantage in their impact to other neurotransmitters at higher dosages, I would always defer to Ian about.

I suspect doctors know less about SNRI's than they do about SSRI's. It's a confusing classification which I'm starting to believe it's more about drug companies wanting to create something new and your average doctor doesn't look at what the drug really does when compared to some SSRI's.

As far as the age of forum posts goes, just look at this place. Hardly anyone is ever on this med. Ven seems to be used more. Maybe it's more a depression med?

braindead

23-07-17, 18:16

Yeah, you will read learned texts proclaiming that, usually then pontificating that this is because 60mg will block 80% of the serotonin transporters which supposedly is the magic number to produce the therapeutic effect and higher doses don't increase that percentage by much. Sounds really impressive...until you contemplate the French antidepressant tianeptine (Stablon) which not only doesn't block serotonin transporters, it actually increases their efficiency. Yet it seems to be at least as effective as the SSRIs and often works more quickly!

Apart from possibly a spike for a week or two, increasing the dose is unlikely to make anxiety worse. Whether it will make it better will only be determined by trying it.

There may be a generalized answer, but even if a million others all responded the same way, that's no guarantee you will, unfortunately. Everyone's reaction is unique to them.

THANKS my man:shades:

panic_down_under

24-07-17, 05:36

The thing is, doctors will often keep increasing the dosage hoping to see more improvement. This doesn't always achieve anything and they end up switching people.

But it does often enough to make trying higher doses worthwhile, Terry. If my doctors had not explored the upper dose limits I would have been leading the life of what the Japanese call a 'Hikikomori', a recluse imprisoned by agoraphobia, for the last 30 years.

I suspect doctors know less about SNRI's than they do about SSRI's. It's a confusing classification which I'm starting to believe it's more about drug companies wanting to create something new and your average doctor doesn't look at what the drug really does when compared to some SSRI's.

Marketing is probably the major factor, but also most antidepressants were developed before their binding potential could be measured so their supposed effects were based mostly on circumstantial evidence and a fair amount of guessing. Even now binding assays are far from precise, with a 5-10 fold variation quite common even when tested by the same lab. Much of the data is also based on non human receptors and transporters which may reduce its value.

Plus, these are lab results which may or may not reflect what actually happens in a living brain. One of the reason the low serotonin hypothesis gained early credibility is that in test tubes antidepressants do what the hypothesis proposes. It was only dispelled when the invention of microdialysis pipettes allowed researchers to test the hypothesis within living brains. I remember reading a mid 1990s by Chantal Moret and Mike Briley in which they repeated an in vitro experiment they'd done a few years previously, this time using in living rats instead of rat brain slices, and being puzzled by the results failing to replicate the earlier finding. Researchers don't often express surprise in their papers, but they did.

As far as the age of forum posts goes, just look at this place. Hardly anyone is ever on this med. Ven seems to be used more. Maybe it's more a depression med?

Venlafaxine seems to be one of the two most effective antidepressants for pulling the very severely, almost catatonic depressed back from the abyss and has become very popular for general depression because of this. But it really has no advantage in the more usual less severe depressions and given some of its issues such as higher cardio toxicity and the severity of withdrawal is probably best reserved for short-term use to stabilize severe depression before switching to another med for ongpoing maintenance therapy, imho.

braindead

24-07-17, 09:34

THANKS PANIC DOWN UNDER, I had a word with my shrink nurse this morning about my 60mg CYMBALTA and the good way it stunted my depression but seems to leave sleep patterns and anxiety still lingering, and she said straight away go up to 90mg to see if thats the missing link.If tolerated and still not working after a week we try 120mg has a final push , has she and you said all brains work differently. EFFEXOR to me is the spawn of the devil and swore i would never try a SNRI again after my experience, it took me to the brink of suicide with it famed bad start up this was 30 years ago on tablet form venlafaxine, I was given it in mental hospital and the doses were lifted to fast turned me into a space cadet first class nut job. they sent me home and i fired the meds in the bin and did a detox no person should ever go through.there was even a web site called venlafaxine .org to help people get off the med. I have had a lot smoother ride with Cymbalta apart from a split arse Fisher from constipation so hear is hoping 90mg dont hold no gremlins :wacko::wacko::shades:

panic_down_under

24-07-17, 12:48

EFFEXOR to me is the spawn of the devil and swore i would never try a SNRI again after my experience

...I have had a lot smoother ride with Cymbalta

You shouldn't judge other SNRIs by venlafaxine. It is a different beast than the others. Really a SNRI in name only as most of the SSRIs are more potent noradrenaline/norepinephrine inhibitors than it is. That said, the way it was administered didn't do you any favours and may have been at least as big a contributor to what happened as the med. :ohmy:

this was 30 years ago on tablet form venlafaxine

Were they the weird shield shaped tablets? I only took one because it had the same immediate mania effect on me as all the SSRIs I've tried despite the protestation of the shrink that it was a completely different type of med. Not his fault as there was no data to prove otherwise back then.

braindead

24-07-17, 14:00

A guy who live just across the road from me was on 75mg Effexor for years, he became ill and was raised to 150mg , he said he felt great and after a few months had the notion that he didn't need it anymore looking on himself has some kind of middle-class junkie . I think you can guess the next bit he crashed big time . he was put back on 75mg then 150mg he was off work 12 weeks before he went back 6 weeks of that was under the blanket syndrome and 10 week before the Effexor trickled back into his system, all this because he thought he new best. NEVER EVER stop a med thats working , he was lucky it gave him a second chance. I doubt he will make that mistake again.:wacko:

You shouldn't judge other SNRIs by venlafaxine. It is a different beast than the others. Really a SNRI in name only as most of the SSRIs are more potent noradrenaline/norepinephrine inhibitors than it is. That said, the way it was administered didn't do you any favours and may have been at least as big a contributor to what happened as the med. :ohmy:

Were they the weird shield shaped tablets? I only took one because it had the same immediate mania effect on me as all the SSRIs I've tried despite the protestation of the shrink that it was a completely different type of med. Not his fault as there was no data to prove otherwise back then.
No weird shape they were round and a dirty brown colour. in hospital when the med nurse got to my bed she said its a long time since i gave anyone this med , soon has she said that i had a bad feeling:wacko:

panic_down_under

24-07-17, 23:08

A guy who live just across the road from me was on 75mg Effexor for years, he became ill and was raised to 150mg , he said he felt great and after a few months had the notion that he didn't need it anymore looking on himself has some kind of middle-class junkie. I think you can guess the next bit he crashed big time

Yeah. It's not an uncommon story. :sad: Imho, it's a good idea to slowly come off the first antidepressant after about 12 month to see if you can manage without it, and maybe after 18 months the second time, but if there is another relapse within a year or so then taking antidepressants permanently is the best option. In your neighbours case the need to increase the dose just a few months earlier should have been a warning he wasn't ready to go med free.

No weird shape they were round and a dirty brown colour. in hospital when the med nurse got to my bed she said its a long time since i gave anyone this med , soon has she said that i had a bad feeling

Are you sure it was Effexor? It was only approved in 1993 so would have been a new drug if you were on it about 30 years ago. It was originally made in 25mg, 37.5mg, 50mg, 75mg and 100mg tablets, all shield shaped and pinkish peach coloured.

braindead

25-07-17, 08:53

Yeah. It's not an uncommon story. :sad: Imho, it's a good idea to slowly come off the first antidepressant after about 12 month to see if you can manage without it, and maybe after 18 months the second time, but if there is another relapse within a year or so then taking antidepressants permanently is the best option. In your neighbours case the need to increase the dose just a few months earlier should have been a warning he wasn't ready to go med free.

Are you sure it was Effexor? It was only approved in 1993 so would have been a new drug if you were on it about 30 years ago. It was originally made in 25mg, 37.5mg, 50mg, 75mg and 100mg tablets, all shield shaped and pinkish peach coloured.
SORRY it was it was only 10 YEARS AGO last i was in hospital that's when i was given EFFEXOR THE DOSES WERE 37.5MG - 75MG -150MG -300MG my first ever med that worked was PROZAC it had not been out long, before that i lived on ATIVAN in them days they gave them out like sweets, in my teens and twenties i relied on alcohol i was singing in a pop band and needed the skinny look , has we all no you dont get that with ADs , in those years i was mad- bad on ATIVAN and booze and a sex god :wacko:later i started to get breakdowns in my 30tis never recovered, now i paly the AD GAME and still have a tollarance of 6mg a day LORAZAPAM without them im nuked:shades:

MyNameIsTerry

27-07-17, 06:29

But it does often enough to make trying higher doses worthwhile, Terry. If my doctors had not explored the upper dose limits I would have been leading the life of what the Japanese call a 'Hikikomori', a recluse imprisoned by agoraphobia, for the last 30 years.

Marketing is probably the major factor, but also most antidepressants were developed before their binding potential could be measured so their supposed effects were based mostly on circumstantial evidence and a fair amount of guessing. Even now binding assays are far from precise, with a 5-10 fold variation quite common even when tested by the same lab. Much of the data is also based on non human receptors and transporters which may reduce its value.

Plus, these are lab results which may or may not reflect what actually happens in a living brain. One of the reason the low serotonin hypothesis gained early credibility is that in test tubes antidepressants do what the hypothesis proposes. It was only dispelled when the invention of microdialysis pipettes allowed researchers to test the hypothesis within living brains. I remember reading a mid 1990s by Chantal Moret and Mike Briley in which they repeated an in vitro experiment they'd done a few years previously, this time using in living rats instead of rat brain slices, and being puzzled by the results failing to replicate the earlier finding. Researchers don't often express surprise in their papers, but they did.

I don't disagree, Ian. For many that extra helps greatly, it's just that for some the med is a dud and they switch and maybe even increase with that until they find what works. But GP's can also be a bit over zealous upping doses far too quickly or even when the patient is responding well already.

I can understand the drugs companies trialling, getting licenced and then never caring as the watch their reps pull the cash in for them. But the medical professionals you would think would be altering the status of drugs where needed. It just seems led by the companies with often little interest from the docs in changing things because the drugs are plastering over problems in patients.

panic_down_under

27-07-17, 09:05

I can understand the drugs companies trialling, getting licenced and then never caring as the watch their reps pull the cash in for them. But the medical professionals you would think would be altering the status of drugs where needed. It just seems led by the companies with often little interest from the docs in changing things because the drugs are plastering over problems in patients.

A lot of the medical professions, psychiatrists included, have only limited understanding of receptor affinities, etc. The number of posters here on both mirtazapine and quetiapine, which are very *similar in their action is evidence of this.

As for the drug companies, they lose interest as soon as thr patent expires and their market share begins evaporating. That is assuming they cared in the first place. The big players that created the antidepressants most of us are taking have pretty much abandoned psych meds generally, and antidepressants particularly in recent years. Small startups are doing what antidepressant drug development there is, though this may change given recent excitement about ketamine.

braindead

27-07-17, 09:50

I don't disagree, Ian. For many that extra helps greatly, it's just that for some the med is a dud and they switch and maybe even increase with that until they find what works. But GP's can also be a bit over zealous upping doses far too quickly or even when the patient is responding well already.

I can understand the drugs companies trialling, getting licenced and then never caring as the watch their reps pull the cash in for them. But the medical professionals you would think would be altering the status of drugs where needed. It just seems led by the companies with often little interest from the docs in changing things because the drugs are plastering over problems in patients.
TERRY what dose of CYMBALTA do you take :whiplash:

MyNameIsTerry

27-07-17, 16:09

60mg. It was a nightmare for me on that dose and the following year was far worse than the previous one. I was a total mess. If I had known then what I do now I would have come off it. I was obsessive as hell with the explosion of OCD I had.

It just didn't suit me. I was on Cit previously at 20mg and that worked much better for me.

Going up would just mean I got worse but my GP should have pulled me straight off this med.

braindead

27-07-17, 17:17

60mg. It was a nightmare for me on that dose and the following year was far worse than the previous one. I was a total mess. If I had known then what I do now I would have come off it. I was obsessive as hell with the explosion of OCD I had.

It just didn't suit me. I was on Cit previously at 20mg and that worked much better for me.

Going up would just mean I got worse but my GP should have pulled me straight off this med.
CITALOPRAM was the same to me has Cymbalta to you the spawn of the devil. I have used all ssris apart from Paxil and put escitalopram has no 1, why in hell was you on a med 2 years that didnt work.???????????????:wacko:

MyNameIsTerry

27-07-17, 17:25

I'm still on it, may be 5 years nearly now. I found ways to reduce my anxiety and I guess I have adjusted, although I still experience regular flare ups which are nowhere near as bad as back then. For me it's like the side effects just ran for a very long time as my symptoms were nothing like what I had before. I was too messed up to sort through the issue and trusted my GP. Back then I had no therapy and just listened to him about anxiety, I didn't put time into reading about it as I thought he was giving get me what I needed to know.

I need to get off it really but I'm loathed to let my GP play med lottery after getting to a better place. I've found Omega 3 stops the mood swings caused by this med and I'm trying out other things to see if it deals with the other issues and then I shall come off it knowing it will be safer.

I wonder whether the Serotonin element was helping me but the NE was fighting against?

braindead

27-07-17, 17:43

with all meds that are for depression and anxiety, the depression has to be nuked before it makes a start on the anxiety, could be months before you get any relief from anxiety . lots of people think it works on both at the same time boy are they in for a shock :lac:

pulisa

27-07-17, 18:02

braindead, could I ask why you were prescribed ssri drugs when you have a bipolar diagnosis?

braindead

28-07-17, 10:31

braindead, could I ask why you were prescribed ssri drugs when you have a bipolar diagnosis? OFF COURSE GOOGLE WOULD BE QUICKER

http://www.webmd.com/bipolar-disorder/bipolar-ssris

MyNameIsTerry

28-07-17, 10:54

with all meds that are for depression and anxiety, the depression has to be nuked before it makes a start on the anxiety, could be months before you get any relief from anxiety . lots of people think it works on both at the same time boy are they in for a shock :lac:

I definitely felt a little better for a few days about a week into starting the 30mg dose but then it went back to how I felt before I started it. But the 60mg have me the worst about 10 days of my life! Very different symptoms, I hated the adrenaline rushes and constant agitation.

Then within weeks came the OCD...

When I started Cit I quickly became depressed. Giving me a hypnotic gave me a few days where I felt a lot better but I suspect that was more the relief of catching up from the insomnia. Insomnia can be very frustrating!

braindead

28-07-17, 16:32

the 60mg Cymbalta i was started on , so it:wacko: sept ok to me, i decided to try 90mg and i am paying for it now ,i quickly dropped back to 60mg but the 90mg side effects are still dogging me.

MyNameIsTerry

29-07-17, 05:17

It's a short half life drug so it will adjust quickly. Don't be surprised if it lingers though because these experiences can be like a shock and we end up having to get ourselves back to where we were before.

I hope it eases up soon for you. :hugs:

braindead

29-07-17, 16:41

I had a bad night last night no sleep, i just sat up in bed there was nothing else i could do. i am tolerance to 6mg of lorazepam but i can still raise it in an emergency, for a few days i have spare boxes . I also have boxes of olanzapine they are the daddy of anxiety symptoms, but i dont like to use them unless forced or overwhelmed with crippling anxiety , its a med you have to sign for before they script it. that means its not organ friendly:weep: I am visited by my shrink nurse on Tuesday maybe she will have a plan, has i said i have been in depression this time for 1 year and trailed meds , cit, sert,mirt,olanzapine,pregabalin, Cymbalta :wacko:

braindead

30-07-17, 16:47

TERRY your doc has you on 60mg and your not happy why not 40mg there is a 20mg tab ????????????????????? does anyone do well on 40 mg Cymbalta:wacko: